Pseudocoarctation-associated aneurysm in a young female: surgical resection and histological evidence of aortic fragility with five-year surveillance

Pseudocoarctation of the aorta is a rare congenital anomaly characterized by elongation and kinking of the aortic arch without significant pressure gradient. While often asymptomatic, it may be associated with aneurysmal degeneration, necessitating surgical intervention. We report the case of a woman in her 30s who was referred after an abnormal shadow was detected on chest imaging during a routine health checkup. Contrast-enhanced computed tomography revealed elongation and kinking of the distal aortic arch with an associated saccular aneurysm in the descending thoracic aorta. An aberrant left vertebral artery originated independently from the aortic arch. The patient underwent surgical resection and Dacron graft replacement under partial cardiopulmonary bypass. Histopathological examination revealed medial thinning, elastic fiber disruption, and reduced smooth muscle content not only in the aneurysmal segment but also in macroscopically normal adjacent aortic tissue within approximately 10 mm from the aneurysmal margin. No aneurysm recurrence or new aortic pathology was observed during five years of postoperative follow-up. This case suggests that aortic tissue adjacent to pseudocoarctation-associated aneurysms may exhibit localized histological fragility despite a normal gross appearance. Although pseudocoarctation cannot be defined as a distinct aortopathy based on a single case, careful intraoperative assessment and selection of the anastomotic site are essential. No aneurysm recurrence or new aortic pathology was observed during five years of postoperative follow-up, highlighting the importance of long-term imaging surveillance.